Summary

Arthroscopic tranfer of flexor hallucis longus tendon to the calcaneus can be an option for surgical treatment of chronic Achilles tendon rupture with low morbility and excellent functional outcome.

Abstract

Chronic Achilles Tendon Rupture (CATR) usually requires surgical repair and an open procedure is tradicionally performed. There is some experience with arthroscopic transfer of Flexor Hallucis Longus (ATFHL) but most authors recommended this technique only on low demanding patiens
The purpose of this paper is to present our early experience using ATFHL on athletic patients.
We did ATFHL on five non-professional athletes (three runners, one recreational footballer and one surfer), one neglected ruptures and four re-ruptures (after surgical repair). All patients were male and the main age was 31 years old (range 23 to 40 years old). The patients we evaluated after a mean follow-up of 21 months (range 8 to 34 months) using the AOFAS score for hindfoot/ankle.
The mean pre-operative AOFAS score was 63 (range 49 to 79) and a mean post-operative AOFAS score was 99 (range 97 to 100). All patients were able to do single foot heel rise and return to sports at the same level.
One patient had transient hypoesthesia of tibial nerve. No other complications where registered.
CATR can be solved with ATFHL but most author recommend it just for low demanding patients. For the athletic population, the usual solution is an extensive approach with some kind of plasty of the remnant tendon with the inherent morbidity and risk of soft tissue complications.
We present a small group of recreational athletes in which the ATFHL had a good result with a remarkable functional rehabilitation.
All our patients showed by the end of follow-up almost complete functional recuperation of the gastrocnemius complex.
Our experience, although relatively short in term and in numbers, made us believe that the ATFHL may play a role in a treatment of CATR, not only on low demand patients but also in the athletic population.